喹硫平术前用药对老年骨科患者术后谵妄及睡眠质量的影响  

Effects of preoperative quetiapine on postoperative delirium and sleep quality in elderly orthopaedic patients

作　　者：杨亦平 丁依依 王阳阳 王文伟 叶克平 叶琦刚 李军[2] Yang Yiping;Ding Yiyi;Wang Yangyang;Wang Wenwei;Ye Keping;Ye Qigang;Li Jun(Department of Anesthesiology,Affiliated Huangyan Hospital of Wenzhou Medical University,Taizhou 318020,China;Department of Anesthesiology,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325027,China)

机构地区：[1]温州医科大学附属黄岩医院麻醉科,台州318020 [2]温州医科大学附属第二医院麻醉科,温州325027

出　　处：《中华医学杂志》2023年第41期3252-3257,共6页National Medical Journal of China

基　　金：浙江省医药卫生科技平台项目(2021KY1208)

摘　　要：目的探讨喹硫平术前用药对老年骨科患者术后谵妄(POD)及睡眠质量的影响。方法前瞻性选择2021年8月至2023年3月于温州医科大学附属黄岩医院择期在连续腰麻下行膝部或髋部手术老年患者111例,美国麻醉医师协会(ASA)分级Ⅱ~Ⅲ级,随机数字表法分为2组:对照组(C组,术前1 h服用安慰剂)和喹硫平组(Q组,术前1 h服用喹硫平12.5 mg)。C组54例,男25例,女29例,年龄(73.5±4.9)岁;Q组57例,男26例,女31例,年龄(74.8±5.0)岁。主要观察指标为术后24、48、72 h采用意识模糊评估表(CAM)评估患者POD的发生率;次要观察指标为两组患者术后24、48 h匹兹堡睡眠质量指数(PSQI)评分及术后24 h疼痛控制满意度。结果Q组患者术后24、48、72 h的POD发生率分别为5.4%(3/57)、12.5%(7/57)、14.3%(8/57),C组患者分别为18.2%(10/54)、21.8%(12/54)、21.8%(12/54),Q组患者术后24 h的POD发生率低于C组(P=0.036),而两组术后48、72 h的POD发生率差异均无统计学意义(均P>0.05)。Q组患者术后24、48 h的PSQI评分分别为(3.8±1.2)、(6.9±1.1)分,C组患者分别为(10.5±2.8)、(7.3±1.3)分,与C组比较,Q组患者术后24 h PSQI评分提高(P<0.001),而术后48 h PSQI评分差异无统计学意义(P=0.068)。Q组患者术后24 h疼痛控制满意度为(91±7)分,高于C组患者的(81±6)分(P<0.001)。结论术前1 h口服小剂量喹硫平可降低老年骨科膝部或髋部手术患者术后24 h的POD发生率,改善睡眠质量,并提升术后疼痛控制满意度。Objective To investigate the effects of preoperative quetiapine on postoperative delirium(POD)and sleep quality in elderly orthopedic patients.Methods Prospectively,111 elderly patients,American Society of Anesthesiologists(ASA)gradeⅡ-Ⅲ,scheduled to undergo knee or hip surgery in the Affiliated Huangyan Hospital of Wenzhou Medical University under continuous spinal anesthesia from August 2021 to March 2023,were selected and randomly divided into two groups by random number table:control group(group C,1 h preoperative placebo)and quetiapine group(group Q,1 h preoperative quetiapine 12.5 mg).In group C,54 cases were enrolled,including 25 males and 29 females,with an average age of(73.5±4.9)years.In group Q,57 cases were enrolled,including 26 males and 31 females,with an average age of(74.8±5.0)years.The primary outcome measures were the incidence of POD evaluated by using confusion assessment method(CAM)at 24,48,and 72 hours after surgery,and the secondary outcome measures included Pittsburgh sleep quality index(PSQI)scores at 24 and 48 hours after surgery and satisfaction of pain management within 24 hours after surgery.Results The incidence of POD at 24,48,and 72 h after surgery in group Q was 5.4%(3/57),12.5%(7/57),14.3%(8/57),respectively,while that in group C was 18.2%(10/54),21.8%(12/54),21.8%(12/54),respectively.The incidence of POD at 24 h after surgery in group Q was lower than that in group C(P=0.036).There was no significant difference in the incidence of POD at 48 and 72 h after surgery between two groups(all P>0.05).The PSQI score of patients in group Q at 24 and 48 h after surgery were(3.8±1.2)and(6.9±1.1)scores,respectively,which in group C were(10.5±2.8)and(7.3±1.3)scores,respectively.Compared with group C,the PSQI score of patients in group Q at 24 h after surgery was significantly higher(P<0.001),but there was no significant difference at 48 h after surgery(P=0.068).The satisfaction scores of pain management at 24 h after surgery in group Q was(91±7)scores,which was higher than that in

关 键 词：老年人 骨科 术后谵妄 喹硫平 

分 类 号：R614[医药卫生—麻醉学]